PRF vs. Graftless Sinus Lift With Implant Placement

This randomized controlled clinical trial investigates the clinical and radiographic outcomes of crestal sinus floor elevation in the atrophic posterior maxilla, comparing two approaches: one using platelet-rich fibrin (PRF) as a sole grafting material and another performed without any grafting material. Both interventions are combined with single-stage dental implant placement. The rationale for this study is based on emerging evidence suggesting that graftless techniques, relying on blood clot stabilization and tenting of the sinus membrane, may be sufficient to induce predictable bone formation, especially when residual alveolar bone height is ≥5 mm.

The study involves adult patients presenting with edentulous posterior maxillary regions and limited vertical bone height due to sinus pneumatization and ridge resorption.

Participants are randomly allocated to either PRF or graftless groups. Both groups undergo transcrestal sinus elevation through sequential osteotomy, followed by immediate implant placement under a standardized surgical and prosthetic protocol.

Primary outcomes include radiographic bone gain and implant stability quotient (ISQ), while secondary outcomes include marginal bone loss and peri-implant clinical parameters. Radiographic evaluation is conducted using CBCT imaging at baseline and 6 months postoperatively. This study aims to provide evidence on whether PRF offers added clinical benefit over natural healing and clot formation in sinus lift procedures performed via the less invasive crestal approach.

Inclusion criteria

• Adults aged 25 to 65 years
• Patients with one or more missing posterior maxillary teeth
• Residual alveolar bone height between 5 mm and 7 mm, confirmed by CBCT
• Good oral hygiene and motivation for implant therapy
• Adequate inter-arch space for prosthetic rehabilitation
• Absence of maxillary sinus pathology on radiographic assessment
• Patients willing to undergo single-stage implant placement with sinus lift
• Signed informed consent

Exclusion criteria

• Systemic diseases or medical conditions affecting bone metabolism or wound healing (e.g., uncontrolled diabetes, osteoporosis, immunocompromised status)
• History of radiation therapy in the head and neck region
• Use of medications influencing bone turnover (e.g., bisphosphonates, corticosteroids)
• Active periodontal disease or poor oral hygiene
• Smoking or tobacco use
• Parafunctional habits such as bruxism or clenching
• Pregnancy or breastfeeding
• Known bleeding disorders or abnormal coagulation profiles
• Presence of maxillary sinus infection or pathology
• Inability to attend follow-up visits or comply with study protocol